Each type of cancer is unique, and there’s no one-size-fits-all treatment. Immunotherapy and targeted medications allow doctors to treat cancer using different approaches that help improve overall outcomes.
“Cancer” is an umbrella term for hundreds of conditions involving unusual, uncontrolled cellular growth and spread in your body. Where cancer develops, its unique cellular features, its growth rate, and its response to treatment all determine which type of cancer makes up your diagnosis.
And just as cancers are unique and varied, so are the treatments for cancer. Immunotherapy and targeted medications are two relatively new cancer treatment options that work by enhancing your immune response or interrupting a specific process on the timeline of cancer’s growth and spread.
Immunotherapy and targeted medications are both types of advanced cancer treatment, but they work in different ways.
Immunotherapy boosts or changes your natural immune response, while targeted therapy “targets” specific processes, substances, or cellular functions involved in cancer’s growth, survival, and spread.
Targeted therapy typically affects cancer cells directly, while immunotherapy focuses on your immune system. But some types of immunotherapies are also targeted therapies, and some targeted therapies are also immunotherapies.
For example, a targeted medication might also be an immunotherapy if it works on a precise instance within the immune response (checkpoint inhibitors and monoclonal antibodies are two examples of this).
How does immunotherapy work?
Immunotherapy is a type of biologic therapy. Biologics are made using components of living organisms, such as proteins, enzymes, or sugars, which help them seamlessly interact with the natural processes of your body.
In cancer, immunotherapy is used to enhance your existing immune response against cancer cells. Some immunotherapies boost your immune system’s strength, and others help it work more effectively.
Types of immunotherapies for cancer include:
- CAR-T cell therapy: This treatment involves infusing modified T cells from your own body that are engineered to better recognize cancer cells.
- Checkpoint inhibitors: These work by blocking certain proteins that protect cancer cells from your immune response.
- Cancer vaccines: Vaccines introduce cancer-specific antigens into your body to help train your immune system to identify and eliminate cancer cells.
- Monoclonal antibodies: These antibodies mark cancer cells for easier identification by your immune system.
- Immune system modulators: These enhance your overall immune response by adding proteins to your body, such as interferons and interleukins.
How does targeted therapy work?
Targeted medications for cancer are considered a type of chemotherapy. “Chemotherapy” is a collective term for the administration of any chemical to destroy cancer cells.
Targeted medications work by interrupting specific processes that are essential to cancer’s growth or spread. Most of these medications are “small molecule drugs” or monoclonal antibodies.
Small molecule drugs are made of tiny molecules that allow them to slip past the cell membranes of cancer cells. Once inside, they target intercellular enzymes, receptors, or proteins involved in cancer cell signaling.
Examples of small molecule targeted medications include:
- tyrosine kinase inhibitors
- proteasome inhibitors
- PARP inhibitors
- MEK inhibitors
- BRAF inhibitors
- ALK inhibitors
- mTOR inhibitors
- CDK4/6 inhibitors
Monoclonal antibodies, as targeted therapies, work by binding to specific receptor sites on cancer cells. Receptor sites are necessary for cancer’s growth and spread because they allow hormones and other signaling molecules to activate cellular processes. When receptor sites are blocked, cancer cell activity can be shut down or slowed.
In certain targeted treatments, some monoclonal antibodies are engineered to deliver cell-destroying chemicals to cancer cells once they bind to receptor sites.
Other monoclonal antibodies block regulatory molecules for your immune response, allowing a stronger reaction against cancer cells.
Types of monoclonal antibodies include:
- naked monoclonal antibodies (antibodies unattached to other drugs)
- conjugated monoclonal antibodies (antibodies linked to a drug or toxic particle)
- bispecific monoclonal antibodies (antibodies that can target two receptors at the same time)
How immunotherapy or targeted therapy makes you feel depends on many factors, including your cancer diagnosis, your overall health, and the specific treatment you’re receiving.
Several studies have suggested that treatment with immunotherapy — specifically checkpoint inhibitors — is associated with a higher quality of life than other cancer treatment regimens.
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Checkpoint inhibitors are both an immunotherapy and a targeted therapy because they affect a very specific aspect of your immune system.
Other targeted therapies might not be as supportive of overall quality of life. According to a
Immunotherapy and targeted therapy offer both unique and overlapping benefits when it comes to cancer treatment.
Immunotherapy:
- can be used across a broad range of cancers
- is an option for people with treatment-resistant cancers or advanced cancers
- can result in long lasting remission and improved survival outcomes
- may help permanently modify your immune system against cancer cells
- can be added to other cancer therapies to increase treatment effectiveness
Targeted therapy:
- allows for precise and customizable cancer treatment
- is more likely to spare noncancerous cells from negative effects
- may result in fast improvements in certain types of cancer, such as those with specific genetic features
- can be added to other cancer therapies to enhance treatment effectiveness
- is an option for people with advanced or treatment-resistance cancers
Like most other types of therapies, immunotherapy and targeted therapy for cancer have drawbacks and are not appropriate or effective for everyone.
Immunotherapy:
- has broad effectiveness but does not work for all types of cancer
- can be affected by your overall health and the state of your immune system
- may cause immune-related adverse events, in which your modified immune response creates toxic effects throughout your body
- can take time to change the immune response enough to cause noticeable benefits
- may become less effective over time as cancer cells become resistant
- sometimes also affects noncancerous cells
Targeted therapies:
- might work for only very specific cancers
- may become less effective over time as cancer cells become resistant
- can change the function of noncancerous cells that share therapeutic targets
- have variability in individual outcomes and treatment response
Each immunotherapy and targeted therapy medication for cancer comes with its own set of side effects and risks. But in general, immunotherapy may lead to:
- injection site reactions (pain, swelling, redness, rash)
- fever
- dizziness
- weakness
- chills
- headache
- fatigue
- body aches
- trouble breathing
- blood pressure changes
- heart palpitations
- sinus congestion
- fluid retention
- organ inflammation
- diarrhea
- an increased rate of infection
In rare cases, life threatening allergic or inflammatory reactions
Targeted therapies can cause side effects such as:
- diarrhea
- liver problems
- problems with wound healing and blood clotting
- high blood pressure
- fatigue
- hair color loss
- skin changes
- nail changes
- mouth sores
In rare cases, certain targeted therapies can interfere with the function of noncancerous cells, leading to the development of a perforation (hole) in the wall of your:
- gallbladder
- stomach
- esophagus
- stomach
- small intestine
- large bowel
- rectum
Diarrhea and liver problems are the
Cancer treatment of any kind can bring unpleasant side effects, and they’re sometimes part of the process. When the side effects of treatments affect your daily life or limit your ability to function, your oncology team can help you find ways to manage those side effects.
Focus on beneficial lifestyle habits
Improving other aspects of your health can keep your body strong during immunotherapy and targeted therapy treatment for cancer. Eating a balanced, nutrient-dense diet; getting regular exercise; and focusing on getting quality sleep are foundational concepts for improving your overall well-being.
The stronger your body becomes, the fewer side effects you might experience from your cancer treatments.
Join support networks and communities
Interacting with others who share your cancer experience can be empowering, comforting, and validating. You can learn about what others have done to manage their side effects and which treatments have worked best for them.
Keep in constant communication with your oncologist
Your oncologist is your cancer specialist. If you’re experiencing side effects from immunotherapy or targeted medications, your oncologist may be able to recommend an over-the-counter product that can help. They may also be able to review your medication dose and frequency to see whether an adjustment might reduce negative reactions.
Additionally, your oncologist can make referrals to other experts, such as a registered dietitian or a physical therapist, who can help you manage side effects.
Make stress management part of your routine
Stress isn’t inherently negative, but chronic stress — like the type you experience when living with a cancer diagnosis — can keep your body locked in survival mode. As a result, inflammatory processes and prolonged physiological reactions can cause damage throughout your body.
When you’re experiencing treatment side effects, chronic stress can lower your body’s resiliency and may make your symptoms worse.
Adding stress management strategies to your daily or weekly routine can help reduce the long-term effects of stress. Meditation, progressive muscle relaxation, and physical activity are some options to help manage stress.
Discuss your experiences with loved ones
The more those around you know about your diagnosis and the side effects you’re experiencing, the more understanding and empathy they can provide. Letting loved ones know when you’re facing certain challenges from cancer treatment encourages an atmosphere of patience, support, and comfort rather than one of judgment.
Immunotherapy and targeted medications are advanced treatment options for cancer. Immunotherapies affect your immune system and its functions, while targeted therapies pinpoint precise functions, processes, and substances essential to cancer’s growth, survival, and spread.
While immunotherapies typically focus on your immune system and targeted therapies primarily affect cancer cells directly, there is some overlap between these treatments.
If you’re considering whether immunotherapy or targeted therapy is right for you, your oncologist can discuss your eligibility for each treatment based on your diagnosis, overall health, and past experiences with other cancer medications.